Acne keloidalis mainly affects young to middle-aged men and usually presents with firm smooth papules to small nodules on the nape of the neck.
A 38-year-old man presented with a five-year history of mildly itchy and occasionally painful firm papules and small nodules on the midline of the lower occipital scalp extending on to the posterior surface of the neck. Individual lesions started as inflamed small nodules that sometimes weeped and crusted over, some with small pustules. The patient picked at them from time to time but more often left them alone. He had no acne elsewhere and his health was otherwise normal.